The Morning Jolt

Health Care

The All-about-Vaccines Edition

A person receives a coronavirus vaccine at a community vaccination event in Martinsburg, W. Va., March 11, 2021. (Kevin Lamarque/Reuters)

Vaccines, vaccines, vaccines! The Biden administration finally starts thinking about what to do with that Raiders-of-the-Lost-Ark-esque warehouse full of not-yet-approved AstraZeneca doses in Baltimore, European countries get hesitant about AstraZeneca’s vaccine while doing an atrocious job of vaccinating their own citizens, and another media institution cherry-picks the data to make a blue state look good and a red state look bad.

Checking In on That Giant Warehouse of Vaccine Doses Waiting to Be Used . . .

Back on January 29, the Baltimore Sun wrote about the manufacturing plant in East Baltimore that had already made “tens of millions of doses” of the Johnson & Johnson and AstraZeneca vaccines, which, as of this point, had not been approved for use by the FDA.

On February 22, the Washington Post revealed that the plant was slated to manufacture 400 million doses. And yet, a few days later when the FDA approved the emergency-use authorization, Johnson & Johnson said “3 million to 4 million doses of the vaccine could be available in the United States by the end of next week.” Apparently, that East Baltimore warehouse was storing lots of prepared doses of the  AstraZeneca vaccine.

This morning, the New York Times returns our attention to that warehouse full of a vaccine that lots of other governments have approved, but that is not yet authorized for Americans. And this situation isn’t entirely the FDA’s fault; AstraZeneca hasn’t even applied for emergency-use authorization yet.

About 30 million doses are currently bottled at AstraZeneca’s facility in West Chester, Ohio, which handles “fill-finish,” the final phase of the manufacturing process during which the vaccine is placed in vials, one official with knowledge of the stockpile said.

Emergent BioSolutions, a company in Maryland that AstraZeneca has contracted to manufacture its vaccine in the United States, has also produced enough vaccine in Baltimore for tens of millions more doses once it is filled into vials and packaged, the official said.

But although AstraZeneca’s vaccine is already authorized in more than 70 countries, according to a company spokesman, its U.S. clinical trial has not yet reported results, and the company has not applied to the Food and Drug Administration for emergency use authorization. AstraZeneca has asked the Biden administration to let it loan American doses to the European Union, where it has fallen short of its original supply commitments and where the vaccination campaign has stumbled badly.

The administration, for now, has denied the request, one official said.

They may want to rethink that decision soon, because America is steadily working its way down the list of citizens from the most vulnerable to the least vulnerable. We’re about to cross the 100-million-doses-administered threshold; more than 19 percent of Americans have received one shot, and 10 percent have received both. While we’ve seen a few institutions vaccinating young, healthy people, the U.S has generally done a good job of vaccinating the most vulnerable first: 25.5 percent of all doses administered have gone to those over 75; 53.5 percent have gone to those over age 64, and 73.5 percent have gone to those over age 50. (And America has plenty of people under age 50 who have conditions that put them at higher risk for serious complications from COVID-19.)

Thankfully, we’re already seeing results. Our seven-day rolling average of daily new deaths hasn’t been this low since November. The week of December 20, the U.S. had more than 33,000 cases of COVID-19 in nursing homes, and more than 6,000 deaths. The week of February 28, we had just 1,463 cases and 763 deaths.

Those AstraZeneca doses aren’t doing anyone any good sitting in boxes on shelves in Ohio or Maryland. People will start to fairly ask whether it makes sense to keep them there, waiting to be used on healthy Americans a few months from now, when there are seniors and immunocompromised citizens in allied countries who could really use vaccination today. Remember, it took about three weeks for the FDA to approve the Johnson & Johnson emergency-use authorization.

Speaking of Europe . . .

But yesterday brought another complication: Seven countries in Europe — Denmark, Norway, Austria, Estonia, Latvia, Lithuania, and Luxembourg — have now partially or completely suspended their use of the AstraZeneca vaccine. Meanwhile, French and other EU health officials insist the vaccine is safe.

Danish health authorities on Thursday suspended all AstraZeneca vaccinations for two weeks after a 60-year old woman who had been vaccinated formed a blood clot and died.

The move “follows reports of serious cases of blood clots among people vaccinated with AstraZeneca’s Covid-19 vaccine”, the Danish Health Authority said in a statement.

But it cautiously added that “it has not been determined, at the time being, that there is a link between the vaccine and the blood clots”.

Norway soon followed suit, supending all AstraZeneca vaccinations.

Austria earlier announced it had suspended the use of a batch of AstraZeneca vaccines after a 49-year-old nurse died of “severe blood coagulation problems” days after receiving an anti-Covid shot.

Four other European countries — Estonia, Latvia, Lithuania and Luxembourg — have also suspended the use of vaccines from this batch, which was sent to 17 European countries and consisted of one million jabs.

By the way, most of Europe’s vaccine rollout has been disastrous, and the effort in some EU countries makes even the slowest and inefficient American states look good in comparison: “In Belgium, Hungary, the Netherlands and Slovenia, less than one-third of Oxford/AstraZeneca doses that were delivered have been administered up until March 7.” Oh, and the EU exported 34 million doses to other countries. Apparently, some governments are so terrified of being accused of “vaccine nationalism” that they’re exporting massive shipments of doses while their own citizens can’t get one.

(I don’t want to hear one more word about those allegedly wise and sophisticated Europeans and how much better their governments and socialized-medicine systems are.)

Meanwhile, we may soon have a fourth thoroughly effective vaccine available for Americans. It looks like Novavax has another winner:

There were no cases of severe illness or deaths among those who got the vaccine, the company said, in a sign that it could stop the worse effects of new variants that have cropped up.

The vaccine was 86 percent effective in protecting against the more contagious virus variant first discovered and now prevalent in the United Kingdom, for a combined 90 percent effectiveness rate overall based on data from infections of both versions of the coronavirus.

In a smaller trial conducted in South Africa — where volunteers were primarily exposed to another newer, more contagious variant widely circulating there and spreading around the world — the Novavax vaccine was 55 percent effective, based on people without HIV, but still fully prevented severe illness.

That 55 percent may not sound great compared to the other figures, but if it’s preventing severe illness, let’s get those shots in arms. (And notice that South Africa, despite being the origin point for that variant, is enjoying a similarly steep decline in cases and deaths.)

The bad news is, Novavax was projecting FDA approval for its vaccine by May.

Last night, Biden announced he was directing all states, tribes, and territories to make all adults — people 18 and over — eligible to be vaccinated no later than May 1. (The president doesn’t really have the authority to make states do this, but considering the current pace, it’s a reasonable and achievable goal.) The Novavax vaccine will probably be approved just in time to vaccinate the youngest, healthiest, and least-vulnerable American adults.

Ah, That Familiar Red State-Blue State Narrative

Meanwhile, Politico’s evening newsletter discussed the vaccination pace in different states and used Rhode Island as an example of a state doing it right, and Texas as an example of a state doing it wrong: “Texas has one of the country’s slowest moving vaccination campaigns: About 16 percent of Texans have gotten one dose of a Covid vaccine. About half a dozen states — including Alaska, New Mexico, South Dakota, North Dakota, Connecticut and Rhode Island — have vaccinated about a quarter of their populations.”

I would try to avoid conflating the terms “vaccinated” and “given one dose” as Politico does above; Rhode Island has given a quarter of its residents one shot, but only 9.6 percent of them are fully vaccinated. Texas has 9 percent of its residents fully vaccinated. Percentage-wise, that’s not all that dramatic a difference — and remember that nine percent of Texas adults is 1.94 million people, while 9.6 percent of Rhode Island adults is 82,070 people.

Smaller, less-populated states are just going to have an easier time generating impressive numbers in this effort. Each time you put shots into the arms of 215,000 adults in Texas, you’ve increased the state’s vaccinated percentage of adults by one percentage point. Each time you put shots into the arms of 215,000 adults in Rhode Island, you’ve increased the state’s vaccinated percentage by 25 percentage points.

If you just want to measure which state has given the highest percentage of citizens one dose, New Mexico tops the list as of this morning, followed by Connecticut and Alaska. If you just want to measure which state has given the lowest percentage of citizens one dose, it’s Georgia (13.9 percent), followed by the District of Columbia (15.4 percent) and Alabama (16.1 percent).

Rhode Island can justifiably brag that it has used 81 percent of its allocated doses, while Texas has used 73 percent. But the states at the top of the list, as of this morning, are New Mexico (87 percent), Wisconsin (85.1 percent), and North Dakota (84.4 percent). At the bottom of the list, as of this morning, are Georgia (63.3 percent), the District of Columbia (65.4 percent), and Kansas (66 percent). It would be just as valid to write a story featuring North Dakota as a place that’s doing it right and the District of Columbia as a place that’s doing it wrong.

A flyover state proving to be better than the nation’s capital at managing and running a complicated and urgent process? Imagine that!

ADDENDUM: In case you missed it yesterday, when a political party’s leader gets caught in some scandal or bad behavior, and it’s really bad and gets impossible to deny, a lot of his allies will often take the position that the leader ought to resign . . . but that they don’t support removing him from office. That . . . doesn’t make a lot of sense. Very few wrongdoings should fit in that sweet spot where they’re bad enough to warrant resignation, but not quite bad enough to spur impeachment or removal from office.

In other words, Democrats in the New York state legislative: Either take action to remove Andrew Cuomo or declare that the six separate allegations of sexual harassment against him are acceptable behavior in an elected official. Calling on Cuomo to resign isn’t going to change a darn thing.

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